Bruises and Blood Spots Under the Skin
Bruises form when small blood vessels under the skin tear or rupture, most often from a bump or fall. Blood leaks into tissues under the skin and causes the black-and-blue color. As bruises (contusions) heal, they often turn colors, including purplish black, reddish blue, or yellowish green. They usually heal within 2 to 4 weeks. Sometimes the area of the bruise spreads down the body in the direction of gravity. A bruise on a leg usually will take longer to heal than a bruise on the face or arms.
Most bruises aren't a cause for concern. They will go away on their own. Home treatment may speed healing and relieve the swelling and soreness from bruises that are caused by injury. But severe bruising, swelling, and pain that start within 30 minutes of an injury may mean a more serious problem, such as a severe sprain or fracture.
If you bruise easily, you may not even remember what caused a bruise. Bruising easily doesn't mean you have a serious health problem, especially if bruising is minimal or only shows up once in a while.
- Older adults often bruise easily from minor injuries. Bruises are most common in injuries to the forearms, hands, legs, and feet. As a person ages, the skin becomes less flexible and thinner because there is less fat under the skin. The cushioning effect of the skin decreases as the fat under the skin decreases. These changes, along with skin damage from exposure to the sun, cause blood vessels to break easily. When blood vessels break, bruising occurs.
- Women bruise more easily than men, especially from minor injuries on the thighs, buttocks, and upper arms.
- A tendency to bruise easily sometimes runs in families.
In some cases after an injury, blood collects and pools under the skin (hematoma). This gives the skin a spongy, rubbery, lumpy feel. A regular bruise is more spread out. It may not feel like a firm lump. A hematoma usually isn't a cause for concern. It's not the same thing as a blood clot in a vein. And it doesn't cause blood clots.
Bruises that don't seem to be caused by an accidental injury may be caused by abuse. It's important to consider this possibility, especially if the bruises can't be explained or if the explanations change or don't match the injury. Report this type of bruising, and seek help to prevent further abuse.
Blood spots under the skin may be either purpura or petechiae. Purpura might look like bruises, but they aren't caused by an injury as most regular bruises are. Petechiae don't look like bruises. They are tiny, flat, red or purple spots in the skin. But they are different than the tiny, flat, red spots or birthmarks (hemangiomas) that are on the skin all the time.
Some people have sudden unexplained bruising or blood spots under the skin, or they may suddenly get bruises more often. This may be caused by:
- A medicine, such as aspirin or blood thinners (anticoagulants).
- An infection that causes the buildup of toxin in the blood or tissues (sepsis).
- A bleeding or clotting disorder, such as hemophilia, von Willebrand disease, thrombocytopenia, or another less common bleeding or clotting disorder.
- Other diseases that affect clotting. Examples include:
- Inflammation of a blood vessel (vasculitis).
- Malnutrition, such as deficiencies of vitamins B12, C, or K, or folate.
Medical treatment for abnormal bruising or blood spots focuses on preventing or stopping bleeding, changing or adjusting a medicine that may be causing the bruising, or treating the medical problem that is causing the bruising.
If the skin is injured over a bruise, be sure to watch for signs of a skin infection.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.
Babies and young children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Being very sleepy or hard to wake up.
- Not responding when being touched or talked to.
- Breathing much faster than usual.
- Acting confused. The child may not know where he or she is.
Abnormal bleeding means any heavy or frequent bleeding or any bleeding that is not normal for you. Examples of abnormal bleeding include:
- Vaginal bleeding that is different (heavier, more frequent, at a different time of month) than what you are used to.
- Rectal bleeding and bloody stools.
- Bloody or pink urine.
- Gums that bleed easily when you eat or gently brush your teeth.
When you have abnormal bleeding in one area of your body, it's important to think about whether you have been bleeding anywhere else. This can be a symptom of a more serious health problem.
Many prescription and nonprescription medicines may reduce your blood's ability to clot and cause bruising or bleeding under the skin. A few examples are:
- Aspirin and other medicines (called blood thinners) that prevent blood clots. Also, taking a nonprescription medicine with a blood thinner may increase your risk of bruising and bleeding.
- Medicines used to treat cancer.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (for example, Advil or Motrin).
- Steroids, such as prednisone.
Symptoms of infection may include:
- Increased pain, swelling, warmth, or redness in or around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it's hard for you to function).
- Shaking chills.
Symptoms of serious illness in a baby may include the following:
- The baby is limp and floppy like a rag doll.
- The baby doesn't respond at all to being held, touched, or talked to.
- The baby is hard to wake up.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
You may be able to use home treatment to help relieve pain, swelling, and stiffness.
It's important to rest and protect the bruised area.
- Use ice.
Ice will reduce pain and swelling. Apply ice or cold packs right away to prevent or reduce swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.
- For the first 48 hours after an injury, avoid things that might increase swelling. These things include hot showers, hot tubs, hot packs, and drinks that contain alcohol.
- After 48 to 72 hours, if swelling is gone, apply heat. You can start gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend switching between hot and cold treatments.
- Wrap the bruised area.
Compression, or wrapping the bruised area with an elastic bandage (such as an Ace wrap), will help reduce swelling. Don't wrap it too tightly, because that can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage.
- Elevate the bruised area.
Try to keep the area at or above the level of your heart to help reduce swelling. Prop up the bruised area on pillows while you apply ice and anytime you sit or lie down.
- Rub the area.
Gently massage or rub the area to relieve pain and encourage blood flow. But don't massage the bruised area if it causes pain.
- Use pain medicines.
Be safe with medicines. Read and follow all instructions on the label. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
- Think about using alternative medicine.
If you'd like, apply a natural product directly to the bruise.
- Witch hazel may help heal damaged veins.
- Arnica may stimulate healing.
- Do not use tobacco.
Don't smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair.
If you need to use a wrap for more than 48 hours, you may have a more serious injury that needs to be checked by a doctor.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- New or worse signs of infection, such as redness, warmth, swelling, pus, or a fever.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: March 9, 2022
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine